Osteoarthritis is the most common cause of musculoskeletal disability, affecting five million people in Britain. By far the majority of cases are managed in the community. A considerable proportion of patients self-medicate, while others are treated by a GP and the primary health care team. This book provides an overview of the condition, its causes and natural history. Diagnosis of osteoarthritis is also explained including descriptions of joint examination, monitoring of progression and assessment of disability. The book advocates a practical approach to osteoarthritis care, the mainstay of which is patient education and symptom management. It provides advice on both pharmacological and non-pharmacological pain management, the use of exercise, physiotherapy and weight loss where necessary. Topics discsussed also include: informing the patient of the disease and its prognosis; ways in which patients can adapt their home and their lifestyle to work within their physical capabilities; and surgery options.Content: Chapter 1 Introduction (pages 1–3): Chapter 2 Osteoarthritis, Aetiology and Epidemiology (pages 4–18): Chapter 3 Diagnosis and Differential Diagnosis of Osteoarthritis (pages 19–32): Chapter 4 Examination of Joints (pages 33–54): Chapter 5 Assessment of Osteoarthritis Including Hand Osteoarthritis (pages 55–65): Chapter 6 Management Options?Education, Behavioural and Environmental (pages 66–77): Chapter 7 Physical Therapy and Mechanical Interventions (pages 78–84): Chapter 8 Pharmacological Treatment (pages 85–96): Chapter 9 Surgical Options and Procedures (pages 98–114): Chapter 10 Long?Term Management and Referral (pages 115–120): Chapter 11 Economic and Research Considerations (pages 121–126):

Primary CareComments Off on Pharmacy and the U.S. Health Care System, Third Edition

Jan272019

The healthcare field is rapidly evolving, compelled by technological strides, pressure to increase efficiency, and demand to contain costs. Pharmacy and the U.S. Health Care System, Third Edition is the classic text used to prepare pharmacists for independent practice in today’s unpredictable environment since the first edition was published in 1991. This new edition is now streamlined and tailored for a one-semester course, completely updated with the most recent data, statistics, and emerging issues relevant to today’s pharmacy professional, with new chapters devoted to the political realities of the industry and the future of pharmacy.

“Why are there no effective treatments for my condition? Why do researchers exclude patients with primary progressive multiple sclerosis from enrolling in clinical trials? Please let me know if you hear of studies that I might be allowed to enter or treatments that I could try for my condition. ” Thus, in recent years, the sad lament of the patient with primary progressive MS (PPMS). This variant, often in the guise of a chronic progressive myelopathy or, less commonly, progressive cerebellar or bulbar dysfunction, usually responds poorly to corticosteroids and rarely seems to benefit to a significant degree from intensive immunosuppressive treatments. In recent years, most randomized clin­ ical trials have excluded PPMS patients on two counts. Clinical worsening devel­ ops slowly in PPMS and may not be recognized during the course of a 2-or 3-year trial even in untreated control patients. This factor alone adds to the potential for a type 2 error or, at the very least, inflates the sample size and duration of the trial. In addition, there is mounting evidence that progressive axonal degeneration and neuronal loss (rather than active, recurrent inflammation) may be important components of the pathology in this form of the disease. Although contemporary trials are evaluating whether PPMS patients may benefit from treatment with the ~-interferons and glatiramer acetate, preliminary, uncontrolled clinical experi­ ence suggests that the results may not be dramatic.

The National Primary Care Research and Development Centre series provides policy makers, commissioners, managers, primary care professionals and user organizations with up-to-date multi-disciplinary research on important issues that inform future decision making for primary care development. This book examines the key factors shaping the relationship between demand for, and use of, primary care. It provides a detailed picture with which to inform the planning of appropriate, acceptable and responsive primary care services. Patients’ perceptions are important, not only because they are a barometer of the appropriateness and effectiveness of services, but because they are a unique source of knowledge about the way in which people use services when they do, for the reasons that they do. This book concisely presents empirical findings and summarizes key policy and conceptual issues. Other titles in the National Primary Care Research and Development Centre series: NPCRDC: What is the Future for a Primary Care-led NHS? NPCRDC: Primary Care and Social Services: developing new partnerships for older people NPCRDC: Better Building for Better Services NPCRDC: Specialist Outreach Clinics in General Practice NPCRDC: Primary Health Care and the Private Secto

Primary CareComments Off on What Is The Future For A Primary Care Led Nhs?

Jan042019

Other titles in the National Primary Care Research and Development Centre series: NPCRDC: Primary Care and Social Services: developing new partnerships for older people NPCRDC: Primary Care: Understanding Health Need and Demand NPCRDC: Better Building for Better Services NPCRDC: Specialist Outreach Clinics in General Practice NPCRDC: Primary Health Care and the Private Secto

Over 90% of contact between patients and doctors takes place in general practice, making it a valuable research arena, but many members of the primary care team are unaware of the opportunities for them to do research. This book provides information on the research options for individuals and practices, and describes research work undertaken recently by GPs and their teams in a variety of practice settings. It is easy to read, and assumes no previous knowledge of the subject. It is ideal for GPs and all members of the primary healthcare team, especially practice and community nurses, GP registrars and pharmacists. Research Opportunities in Primary Care covers everything from being part of a research network to undertaking a higher degree, and describes the impact of research involvement on the professional and the practice. Sections of each chapter are written by people actually doing research in this setting, to give a ”hands on” feel of what it means in practical terms. This new text creates a set of practical notes enhanced by specific examples of service-based activity. It complements Research Methods in Primary Care, which introduces the range of relevant skills to provide a solid basis for starting research.

‘Fundamental changes in the Health Service demand a radical shift in approaches to patient core. The NHS is becoming increasingly led by the primary care sector. This has a greater meaning than simply more involvement of GPs in secondary care purchasing. It means that we start from where the patient is, in their own home and community. We provide care for them there and only move them into secondary services if and when it is appropriate to do so. ‘Extending Primary Care shows that it is possible to experiment beyond traditional boundaries in these areas. It will provide encouragement to people who work in some of these difficult settings by showing what can be done… This book could not be more timely as a resource to many managers who will need to extend their own understanding of primary care – in the fullest sense of the whole team of people in primary care and the associated community health services.’ From the Foreword by Barbara Stocking

The thoroughly updated second edition of this key textbook provides an authoritative discussion of cardiovascular disease for the practicing primary care clinician. It examines a variety of disease states with emphasis on risk factors, risk estimation, and established cardiac disease. The book also explores the co-morbid conditions that surround cardiovascular disease. It includes key points, algorithms, case studies, recommendations on evidence-based practice, and summary boxes. A key resource for the busy practitioner, the Second Edition of Comprehensive Cardiovascular Medicine in the Primary Care Setting is designed to give residents, fellows, and primary care physicians the skills to confidently perform assessments, initiate and maintain efficacious therapy, and know when a referral to a cardiologist is advisable.

Bringing together the most up-to-date information on all aspects of primary and revision total ankle replacement (TAR), this definitive text focuses on TAR procedures and prostheses available for use in North America with additional “lessons learned” from the international community. The text is evidence-based, includes bullet points for quick reference, and is heavy on step-by-step photographs during surgery. Accordingly, the chapter content over four main sections is a purposeful mix of theory, data, and tips/pearls with detailed photographs, tables, and references. Section One provides an introduction to and history of TAR, including a discussion of fixed versus mobile bearings, TAR versus arthrodesis, and current indications and contraindications for primary TAR. Section Two focuses on primary TAR, covering a number of contemporary systems, such as INBONE, INFINITY, SALTO TALARIS and STAR. Secondary procedures with TAR comprise Section Three, including management of wound healing complications, soft tissue injuries, and varus and valgus malalignment. Section Four discusses revision TAR, covering topics such as infected replacements, component subsidence, and limb salvage as well as issues surrounding specific implant failures. Comprehensive yet practical, Primary and Revision Total Ankle Replacement will be the gold standard for books on this topic for many years to come and will provide invaluable instruction to orthopedic surgeons, podiatrists and foot and ankle clinicians worldwide.

Primary CareComments Off on Women’s Health in Clinical Practice: A Handbook for Primary Care

Oct252018

Traditionally, women’s health has been synonymous with obstetrics and gynecology. With the exception of Family Medicine physicians who are trained in obstetric and gynecologic issues, most primary care physicians have received little training in reproductive health issues even though they care for women and girls.

In recent years, there has been growing recognition that sex differences do exist between the organ systems of women and men, and research about male and female physiologic differences has bolstered the growing body of knowledge about sex differences. Women’s Health: A Handbook for Primary Care presents the most recent changes in current research and provides the reader with an easily accessible reference to common women’s health issues.

The topics in this text range from health problems that largely affect only women, like cervical cancer and breast disease, to health problems that present differently in women than in men, such as cardiovascular disease and diabetes. Chapters on polycystic ovary syndrome and oral health issues address health problems that bring together multiple organ systems including reproductive, cardiovascular and dental health. There are also useful chapters not typically found in primary care texts like eating disorders, interpersonal violence and sexual health. Women’s Health: A Handbook for Primary Care is succinct, well organized, and contains easily understood, practical information for the most common health problems seen in women. This volume is a valuable text for anyone who practices primary care medicine.